Risk Management:
Getting the Board "On-Board" to Drive Quality and Safety
What that means for physicians and other hospital leaders
by James B. Couch, M.D., J.D., FACPE
Managing Partner & Chief Medical Officer
Patient Safety Solutions, LLC
(Dr. Couch is also the Patient Safety Risk Management Consultant for Princeton Insurance)
What’s the big deal?
Standards to be found in the Joint Commission’s Accreditation Standards dating back several decades have established the Board of Hospitals (and other accredited institutions) as the ultimately accountable group for the quality and safety of care. There is case law dating all the way back to the middle ‘60s holding a hospital corporately liable for a patient’s negligently inflicted injuries for not having exercised sufficient oversight of its physicians’ clinical results for which the board is ultimately responsible. Darling v. Charleston Community Memorial Hospital 33 Ill. 2d 326, (1965). So why has getting the “Board on Board” become such a catchy phrase, especially among those signing on to the latest 5 Million Lives Campaign promoted by the Institute for Healthcare Improvement (IHI)? Hasn’t the Board always been on board in overseeing the quality and safety of care right along?
Reality may finally be catching up with the theory of board leadership in patient safety and quality
“Trustees traditionally have used their positions on hospital boards for social networking with other business executives and raising money through events such as fashion shows and golf tournaments... Until the last several years, individual hospital boards in Massachusetts and other states had not paid much attention to the issue of preventable deaths, leaving oversight to doctors and administrators. Now, national and local conferences that encourage greater trustee involvement have been packed, healthcare executives say.” Rowland; Hospital Trustees Shift their Focus to Medical Safety;" Boston Globe; March 5, 2007
Donald Berwick, M.D., President and CEO of IHI, in announcing getting the Board on Board as one of his institute’s six new interventions to decrease the incidence of preventable patient injuries by five million during 2007 and 2008, recently stated: “Board seats in American hospitals have traditionally been relatively honorific positions. It is time for hospital boards of directors—along with executives and physicians—to rise from slumber and view safety as an urgent matter.”
Dr. Berwick, by videotape, and Jim Conway, Senior VP of IHI (and former top executive at the Dana Farber Cancer Institute at Harvard) recently addressed a Leadership Summit Meeting on patient safety sponsored by the New Jersey Hospital Association in Princeton. At that meeting, they explained that for hospital boards to participate in IHI’s 5 Million Lives Campaign, they must:
(1) Set specific aims to reduce medical injuries annually and make an explicit public commitment to measurable quality improvement;
(2) Select and review progress toward safer care as the first agenda item at every board meeting;
(3) Establish, continually update and make transparent to the entire organization a small group of enterprise-wide “roll up” measures of patient safety;
(4) Commit to establish and maintain an environment that is respectful, fair and just for all who experience the pain and loss associated with avoidable harm and adverse outcomes.
(5) Develop their expertise in evaluating quality and safety and set expectations for a similar level of education and training for all staff; and
(6) Hold accountable senior executives for developing and executing a plan to achieve specific quality and safety improvement goals and objectives.